SGLT2 Inhibitor and GLP-1 Receptor Agonist Prescriptions in Newly Diagnosed Type 2 Diabetes Patients With Cardiorenal Risks: A Cross-Sectional Study

Abstract

Aims: The aim of this study is to evaluate the real-world prescribing patterns of SGLT2 inhibitors and GLP-1 receptor agonists (GLP-1RA) in patients with newly diagnosed Type 2 diabetes (T2DM), particularly among those with high cardiovascular risks or chronic kidney disease, and to identify demographic, clinical, and system-level factors associated with receiving these medications. Materials and Methods: This cross-sectional study analyzed electronic medical records (EMRs) of patients with newly diagnosed T2DM from 60 primary care clinics in West Michigan between April 2021 and January 2023. We assessed the documented prescription rates of SGLT2 inhibitors and GLP-1RAs within 3 months of diagnosis based on EMRs, particularly in high-risk subgroups. Results: Overall, 19.9% of n = 5783 patients with newly diagnosed T2DM had either an SGLT2 inhibitor or GLP-1RA prescribed. Prescription rates for these agents were 20.0% for patients with chronic ischemic heart disease and 19.3% for those with impaired kidney function. In adjusted analyses, higher BMI (aOR 2.92 for BMI > 40 kg/m2, 95% CI 1.58–5.42, ref BMI < 24 kg/m2), hyperlipidemia (aOR 1.89, 95% CI 1.28–2.79), chronic ischemic heart disease (aOR 1.55, 95% CI 1.11–2.18), and higher HbA1c (aOR 1.32 per 1% increase, 95% CI 1.22–1.42) were associated with higher odds of receiving prescription of these medications. Conclusions: Despite guideline recommendations, SGLT2 inhibitors and GLP-1RAs are prescribed to only a minority of patients with newly diagnosed T2DM, even among those with clear indications. Efforts to improve guideline-adherent care in primary care settings are needed.